Ganesh, A (2006) A Comparison of the Two Dimensional Ultrasound Guided Technique Versus the Traditional Blind Anatomic Landmark Technique for the Placement of Central Venous Catheter in the Internal Jugular Vein. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Central venous access is an essential part of patient management in many clinical settings. Central venous catheters are used for haemodynamic monitoring, giving vasopressors, cytotoxic drugs, blood sampling, transfusion of blood products, peri-operative intravenous fluidinfusion, and parenteral nutrition.Central venous cannulation is performed in a wide range of locations within the hospital as an elective or emergency procedure. Central venous access is commonly attempted at the internal jugular vein (IJV), subclavian vein (SCV), femoral vein, or arm veins using peripherally inserted central catheters. The actual site chosen in a particular patient should vary based on the indication, individual institutional and operator experiences. In most preoperative patients, IJV is the best route because of it’s reliability and low rate of major complicationswith insertion. The right IJV has a direct path to the right ventricle and is associated with fewest catheter tip malpositions. AIM OF THE STUDY: 1. The purpose of this study was to compare the two dimensional real-time ultrasound guided technique with the traditional blind anatomic landmark technique for the placement of central venous catheter in the internal jugular vein of patients posted for major elective cardiac surgeries. 2. To compare the outcome between the ultrasound guided technique versus the landmark technique in terms of the following parameters : the time taken to locate the IJV with theprobe / pilot needle, time taken to locate the IJV with the 18 G needle, the number of venipunctures, the number of attempts required to successfully cannulate the IJV, the total access time, the success rate, the failure rate, the complication rate. MATERIALS AND METHODS: Study Design: This study was conducted in the Cardio-thoracic operation theatre at the Government General Hospital, Chennai between May 2005 and August 2005 on forty patients posted for elective major cardiac surgery. The study was done after institutional approval and written informed consent was obtained from all the patients included in the study. This study was done in a prospective randomized manner. Forty patients of either sex posted for major elective cardiac surgeries satisfying the selection criteria were randomly allocated into the two groups (Group U, Group L). Group U- Ultrasound group : Patients in this group underwent two-dimensional ultrasound guided right internal jugular vein cannulation. Group L – Landmark group : Patients in this group underwent traditional blind anatomic landmark technique by central approach for right IJV cannulation. Materials used: In this study, a portable two-dimensional ultrasound machine with linear probe of 7.5Mhz frequency manufactured by ESAOTE CARIS PLUS company was used. Sterile probe covering sheaths were used along with sterile conductivity gel (ultra/phonic gel- odourless, sterilized, hypoallergenic aqueous coupling agent for ultrasonic and electromedical procedures). The sterile kit containing the sterile sheath, a gel packet and two elastic bands is available and is marketed by Site~Rite IV Ultrasound System. The triple lumen central venous catheters manufactured by ARROW company for cannulation by Seldinger technique were used. Selection of cases: Inclusion criteria: 1. Age – 12 to 70 years, 2. Elective IJV cannulation. Exclusion criteria: 1. Emergency cannulation, 2. Pregnant women, 3. Coagulopathy, 4. Neck deformities, 5. Local sepsis, 6. History of previous cannulation, 7. History of iv drug abuse, 8. History of IJV thrombosis. SUMMARY: In this study comparing the two dimensional real-time ultrasound guided technique with the traditional blind anatomic landmark technique for the placement of central venous catheter in the internal jugular vein the following parameters have been observed and statistically analysed : the time taken to locate the IJV, the number of venipunctures, the number of attempts required to successfully cannulate the IJV, the total access time, the success rate, the failure rate, the complication rate . 1. The mean time taken with the pilot needle / probe to locate the IJV in the Landmark group - 10.18 + - 1.887 sec, Ultrasound group - 8.88+- 1.333 sec. Significant reduction in the time taken to locate the IJV while using the Ultrasound guided technique. 2. The mean time taken with the 18 G needle to locate the IJV in the Landmark group - 11.84 +- 2.055 sec, Ultrasound group - 9.20 +- 1.443 sec. Significant reduction in the time taken to locate the IJV with 18 G needle while using the Ultrasound guided technique. 3. Successful cannulation at first attempt in the Landmark group - 14/25 – 56%, Ultrasound group - 25/25 – 100%. Significant reduction in the number of attempts required for successful cannulation while using the Ultrasound guided technique. 4. The mean number of venipunctures required for successful cannulation in the Landmark group - 2.16, Ultrasound group - 1.0. Significant reduction in the number of venipunctures required for successful cannulation while using the Ultrasound guided technique. 5. Failure rate Landmark group - 16%, Ultrasound group - 0%. Significant reduction in the failure while using the Ultrasound guided technique. 6. The mean total access time in the Landmark group - 313.36 +- 90.026 sec. Ultrasound group - 252.80 +- 6.602 sec. Significant reduction in the total access time while using the Ultrasound guided technique,thereby facilitating speedy central venous cannulation. 7. Complication rate: a) Carotid artery puncture rate: Landmark group - 24%, Ultrasound group - 0%.b) Haematoma rate - Landmark group - 12%, Ultrasound group - 0%. Significant reduction in the complication rate while using the Ultrasound guided technique. CONCLUSION: Ultrasound guided cannulation of the internal jugular vein significantly improves the success rate, decreases the access time, and reduces the complication rate. The Ultrasound guided technique is a better technique than the traditional blind anatomic Landmark technique for IJV cannulation. The use of ultrasound should be seen as an extension of the traditional skills rather than a completely new technique even though it requires hands-on training. In addition, the Ultrasound guided technique is a potentially useful back-up technique in complicated cases where Landmark technique is unsuccessful. In conclusion,“Two dimensional ultrasound guided internal jugular vein cannulation is quicker, safer, and more successful than the traditional blind anatomical landmark technique”.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Two Dimensional Ultrasound Guided Technique ; Traditional Blind Anatomic Landmark Technique ; Central Venous Catheter ; Internal Jugular Vein. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Apr 2018 15:27 |
| Last Modified: | 16 Apr 2018 15:27 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7026 |
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